title: Changes in cognitive function after carotid endarterectomy in older patients: comparison with younger patients.
abstract: Objective and subjective assessments of changes in cognition after carotid endarterectomy (CEA) were compared between older patients (≥76 years old) and younger patients (<76 years old). Patients underwent subjective cognitive assessment by a neurosurgeon and the patient's next of kin, and neuropsychological testing (five parameters) before and after surgery. Of 37 older patients studied, 4 (11%), 28 (75%), and 5 (14%) patients were defined as having subjectively improved, unchanged, and impaired cognition, respectively, following surgery. Differences in test scores (postoperative test score - preoperative test score: Δ score) in all neuropsychological tests were significantly lower in the older patients than in the 213 younger patients. The Δ score was able to statistically differentiate older patients with subjectively improved, unchanged, and impaired cognition after surgery. Receiver operating characteristic analysis showed that the Δ score cut-off point for detecting subjective improvement (upper cut-off point) and impairment (lower cut-off point) in cognition after surgery in older patients was identical to the mean or the mean +0.5 standard deviation (SD) and the mean -1.5 SD or the mean -1 SD, respectively, of the control value obtained from normal subjects. The upper and lower cut-off points were lower and higher, respectively, than those in younger patients. In conclusion, although neuropsychological test scores reflect the subjective assessment of postoperative change in cognition in older patients, the optimal cut-off points for the test scores to detect subjective improvement and impairment in cognition after CEA are different in older patients compared with younger patients.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Iwate, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Takaaki
authors.initials: T
authors.lastname: Beppu
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Murakami
authors.forename: Takamasa
authors.initials: T
authors.lastname: Nanba
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000367:Age Factors; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000523:psychology; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data; D012372:ROC Curve; D012016:Reference Values; D014888:Wechsler Scales / Q000706:statistics & numerical data